Healthcare Provider Details

I. General information

NPI: 1053629014
Provider Name (Legal Business Name): MEDASSURANT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2010
Last Update Date: 09/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 MONTAGUE PL FLOOR 1
MONTCLAIR NJ
07042-2819
US

IV. Provider business mailing address

71 MONTAGUE PL FLOOR 1
MONTCLAIR NJ
07042-2819
US

V. Phone/Fax

Practice location:
  • Phone: 551-689-7355
  • Fax:
Mailing address:
  • Phone: 551-689-7355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number26NR13475100
License Number StateNJ

VIII. Authorized Official

Name: SARNIA ROBINSON
Title or Position: RECRUITER
Credential:
Phone: 301-809-4000